title: Is octreotide beneficial in patients undergoing pancreaticoduodenectomy? Best evidence topic (BET).
abstract: A best evidence topic was written according to a structured protocol. The question addressed was whether the prophylactic administration of somatostatin or somatostatin analogues in patients undergoing pancreaticoduodenectomy (Whipple's procedure) is beneficial in terms of improved surgical outcomes, reduced morbidity or reduced mortality. A total of 118 papers were found using the reported searches of which 5 represented the best evidence (1 meta-analysis, 1 systematic review and 3 randomized control trials). The authors, date, journal, study type, population, main outcome measures and results were tabulated. There is evidence that the perioperative administration of somatostatin or somatostatin analogues reduces biochemical incidence of pancreatic fistula but, it is still unclear if there is a beneficial effect in the incidence of clinically significant pancreatic fistula. Further adequately powered trials with low risk of bias are necessary. From the available data, somatostatin or somatostatin analogues have no effect on mortality post Whipple's. Interestingly, there are only limited data available on the cost-benefit and financial constraints imposed by this treatment, an issue that has only been addressed in a few studies.
authors.affiliation: Department of Surgery and Cancer, Academic Unit of HPB Surgery, Hammersmith Hospital, Imperial College London, Du Cane Road, London W12 0HS, United Kingdom.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Drymousis
authors.forename: Madhava
authors.initials: M
authors.lastname: Pai
authors.forename: Duncan
authors.initials: D
authors.lastname: Spalding
authors.forename: Long R
authors.initials: LR
authors.lastname: Jiao
authors.forename: Nagy
authors.initials: N
authors.lastname: Habib
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Zacharakis
mesh_terms: D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D015282:Octreotide / Q000009:adverse effects / Q000627:therapeutic use*; D010179:Pancreas / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D015282:Octreotide
keywords: Best evidence topic; Improved outcomes; Octreotide; Pancreatic fistula; Pancreatic surgery; Pancreaticoduodenectomy; Whipple's